Frequently Asked Question about Social Security and Disability Law

Submitted by admin on Fri, 08/15/2008 - 15:51

What is Supplemental Security Income or SSI?

Supplemental Security Income or SSI is federally funded needs based program that was enacted under Title XVI of the Social Security Act. SSI claims are often called Title XVI claims. An applicant can qualify for SSI on the basis of several categories including disability, blindness, or age. An applicant must also have low income and resources as defined by the Social Security Administration. There is also a residence requirement. In addition, an applicant must be a United States citizen or have qualifying alien status. There are many factors that impact whether an applicant has qualifying alien status. Failure to meet any one of the aforementioned categories will render an applicant ineligible for SSI benefits. An applicant does not have to have insured status to be eligible for SSI benefits unlike SSDI benefits.

What is Social Security Disability Income or SSDI?

The Social Security Disability Income or SSDI program is a federal program that was enacted under the Title II of the Social Security Act. In order to qualify for SSDI benefits, an applicant must be under the age of 65 and meet the disability or blindness standard. An applicant must also have insured status. An applicant obtains insured status by working and paying Social Security taxes. An applicant must earn a certain number of credits or quarters of coverage in order to have insured status. Some of these credits or quarters must occur in proximity to the onset date of disability. An applicant who lacks insured status at the onset date of disabilty may not be eligible for benefits. The SSDI program, unlike SSI, is not a needs based program. Financial resources and income are not considered with SSDI claims. A dependent or survivor of the wage earner may be eligible for benefits under some circumstances.

How does the Social Security Administration determine if an adult applicant is disabled?

The disability standard used by the Social Security Administration is a complex 5 step sequential analysis. It is different than the test used by the Department of Veterans Affairs and in worker's compensation cases. The Social Security Administration will make the following determinations:

1. Is an applicant engaged in Substantial Gainful Activity or SGA? This will depend on several factors including whether the applicant is an employee or is self employed. If the applicant is engaged in substantial gainful activity, the claim will be denied.

2. Does the applicant have a severe impairment or combination of impairments? If the applicant's impairments are less than severe, the claim will be denied.

3. Does the applicant meet or equal a listing? The Social Security Administration has over 100 listings for specific physical and mental conditions. Each listing contains specific medical or psychiatric criteria. An applicant who satisfies the criteria for a given listing will be deemed disabled and eligible for benefits without further analysis. If an applicant does not meet or equal a listing, the Social Security Administration must proceed to step 4. The Social Security Administration is constantly revising and updating the listings.

4. Is the applicant capable of performing past relevant work given his or her mental and/or physical impairments? This is generally defined as work that was done in the past 15 years. If the applicant is capable of doing past relevant work, the claim will be denied. If not, the analysis must proceed to the final step.

5. Is the applicant capable of performing other work that exist in substantial numbers in the regional and national economy given his or her mental and/or physical impairments? The Social Security Administration bears the burden of proof at this step. If the applicant is incapable of doing other work, he or she must be found disabled and eligible for benefits and vice versa. An applicant's impairments must be severe in nature and prevent him or her from engaging in substantial gainful activity as discussed above. These impairments must actually last or be expected to last in excess of 12 months or result in death.

Is it possible to qualify for benefits on the basis of mental impairments?

Yes, however, the Social Security Administration will apply the same 5 step sequential analysis that was previously described in determining if a claimant is eligible for SSI and/or SSDI benefits.

Are there specific listings that correspond to mental health or psychiatric conditions?

Yes, the Social Security Administration has many listings that correspond to specific mental health conditions or diagnoses. Several listing are frequently seen in my practice and these include Affective Disorders and Anxiety Related Disorders. Affective Disorders includes Depression and Bipolar Disorder. Anxiety Related Disorders encompasses 5 different conditions including Generalized Anxiety Disorders, Phobic Disorders, Panic Disorders, Obsessive Compulsive Disorders, and Post-traumatic Stress Disorder or PTSD. If a claimant has impairments that meet or equal a given listing, he or she will obtain a favorable decision and be eligible for benefits.

Can I obtain benefits strictly on the basis of drug addiction or alcoholism?

No, a claimant can not qualify for benefits strictly on the basis of drug addiction and/or alcoholism. This does not mean that a person who is an alcoholic or substance abuser can never qualify for benefits. These individuals must be disabled on the basis of other impairments such as mental impairments. The issue of substance abuse or alcoholism must not be material to the disability determination. The Social Security Administration applies a three part test in deciding this issue.

Can a child qualify for SSI benefits?

Yes, children can qualify for benefits. The Social Security Administration will apply a specific analysis in determining if a child is eligible for benefits. This analysis is quite different than the one that applies to adults. It involves 3 steps as opposed to the 5 step sequential analysis for adults.

Do I have to have an attorney to apply for benefits or to appeal an unfavorable decision?

No, a claimant is not required to be represented by an attorney. Studies, however, have demonstrated that a claimant who is represented by an attorney has an increased likelihood of obtaining a favorable decision.

How long do I have to appeal an unfavorable decision?

In general, SSDI and SSI claimants have 60 days to appeal an unfavorable decision. The 60 days starts from the date the claimant receives the letter or notice of an unfavorable decision. The Social Security Administration assumes that a claimant receives the letter or notice 5 days after the date indicated on the letter. A claimant who receives an unfavorable decision should never wait to appeal an unfavorable decision. Claimants who miss the 60 day deadline generally waive their appellate rights unless they can show that there was "good cause" for late filing. The good cause exception has been defined by the Social Security Administration.

I have an upcoming hearing before an Administrative Law Judge, what is involved in a hearing?

Administrative Law Judges preside over Social Security hearings including those involving SSDI and SSI benefits. Social Security claimants and/or other witnesses generally have an opportunity to testify under oath. Administrative Law Judges often ask certain questions of claimants and/or other witnesses regarding their medical and/or mental health status and the specific nature of their impairments. Medical records and other documents are often admitted into evidence. There is often a vocational and/or medical expert called to testify by the Social Security Administration. These experts assist the Administrative Law Judge in determining if a claimant is entitled to SSDI and/or SSI benefits. A hearing is a critical step in the appeals process. Please contact my office if you need additional information regarding your upcoming Social Security hearing.

How much will it cost for attorney representation?

My office handles Social Security initial claims and appeals on a contingency basis. This means that attorney fees are only owed if you win your case. With a favorable decision, attorney's fees are 25% of the back due benefit up to maximum amount which is set by the Social Security Administration. My office presents all clients with a written fee agreement at the outset of representation. There is no charge for case evaluations. (Posted by Attorney Steven A. Ciulla of Reading.)

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